This case report highlights the critical importance of distinguishing physiological athlete's heart from non-ischemic cardiomyopathy and performing thorough electrophysiology evaluation (recognizing pseudo-VAAV responses) for wide complex tachycardia to prevent misdiagnosis of SVT as VT and avoid unnecessary ICD implantation and inappropriate shocks.
Requires careful arrhythmia evaluation in symptomatic athletes; leaves open whether routine screening alters outcomes.
A 25-year-old male presented to his local district general hospital with palpitations, light-headedness, and syncope, often while playing soccer. He had no past medical or surgical history, was not taking any regular medications, and reported no illicit drug use. There was no family history of cardiomyopathy or sudden death. He was an amateur athlete, playing soccer for approximately 12 hours per week and performing aerobic exercise in the gym. The baseline 12-lead ECG was normal (figure 1A). An implantable cardiac monitor (ICM) was inserted, and within one month, multiple episodes of monomorphic wide complex tachycardia (WCT) >250bpm were detected, associated with presyncope (figure 1B).
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Saraf et al. (2025) studied this question.
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